A treatment option for snoring and mild to moderate obstructive sleep apnea, most oral appliances work by supporting the jaw in a forward position to help maintain an open upper airway during sleep. Qualified dentists work with sleep physicians to develop custom-made oral appliances.

According to the American Academy of Dental Sleep Medicine, oral appliance therapy is covered by many medical insurance plans. 

This guide compares oral appliances side-by-side on parameters including warranty, materials, PDAC verification, how it works, fitting, adjustment, and supporting study.

CompanyAirway Management IncApex Dental Sleep LabDream Systems Dental
Sleep Lab		DynaFlexGreat Lakes Dental
Technologies		Luco Hybrid OSA IncOpen Airway
Dental Solutions Ltd		Open Airway
Dental Solutions Ltd		Panthera DentalPanthera DentalProSomnus Sleep
Technologies		ProSomnus Sleep
Technologies		ProSomnus Sleep
Technologies		SICAT GmbH & Co KGSlow Wave IncSomnoMedTomed GmbH
ApplianceflexTAPEMA Serena NylonOASYS Oral / Nasal Airway
System (Optional Tongue
Repositioning Buttons)		DynaFlex Herbst Nylon Sleep HerbstThe Luco Hybrid OSA
Appliance		O2Vent OptimaO2Vent Optima MiniPanthera D-SAD ClassicPanthera D-SAD X3ProSomnus EVOProSomnus EVO [PH]ProSomnus EVO SELECTOPTISLEEPSlow Wave DS8SomnoMed Herbst Advance EliteSomnoGuard SP Pro
Websitewww.tapintosleep.comwww.apexsleep.comwww.dreamsystemdentallab.comwww.dynaflex.com/dental-sleep-medicinewww.greatlakesdentaltech.comwww.lucohybridosa.comopenairway.comopenairway.comwww.pantherasleep.comwww.pantherasleep.comwww.prosomnus.comwww.prosomnus.comwww.prosomnus.comwww.optisleep.comwww.slowwave.netsomnomed.co/en/dentists/productswww.tomed.com
Warranty (days)flexTAP7303651,0957303651,0951,0951,0951,0951,095.751,095 (+730 for Medicare patients)1,095.757301,0951,095730
IndicationsMild-Moderate OSA, SnoringMild-Moderate OSA, SnoringMild-Moderate OSA, SnoringMild-Moderate OSA, SnoringMild-Moderate OSA, SnoringMild-Moderate OSA, Snoring, BruxismMild-Moderate OSA, SnoringMild-Moderate OSA, SnoringMild-Moderate OSA, SnoringMild-Moderate OSA, SnoringMild-Moderate OSA, SnoringMild-Moderate OSA, SnoringMild-Moderate OSA, SnoringMild-Moderate OSA, SnoringMild-Moderate OSA, SnoringMild-Moderate OSA, SnoringMild-Moderate OSA, Snoring
MaterialsThermal Acrylic, Laminate, Nylon, no metal partsNylon, Biocompatible
Nylon		Biocompatible Polymer, Cobalt-Chromium Alloys, Stainless Steel, Hard Acrylic, Laminate, Thermal AcrylicBiocompatible Polymer, Stainless Steel, Hard AcrylicNylonCobalt Chromium Alloys, Stainless Steel, Hard Acrylic3D printed with durable nylon3D printed with durable nylonBiocompatible Polymer, NylonBiocompatible Polymer, NylonBiocompatible Polymer, Medical grade class VIBiocompatible Polymer, Stainless Steel, Medical grade class VIBiocompatible Polymer, Medical grade class VIBiocompatible
Polymer, Hard Acrylic		Hard Acrylic, BioMed ClearBiocompatible
Polymer, Cobalt-Chromium Alloys, Stainless Steel, Hard Acrylic		Laminate, Hard Acrylic, Stainless Steel
PDAC VerifiedYesNoYes (Only OASYS Herbst w/Nasal Dilators & Tongue Lifters)YesYesYesYesYesYesYesYesYesNoNoYesYesNo
How Does the Oral
Appliance Work?		FlexTAP advances the lower jaw with a single point midline advancement. Self-titratable adjustments in 1/3 mm increments aid in easier, faster, and better treatment outcomes.Uses Frantz Design Patent Elastic Mandibular Advancement straps that have been used to treat mild to moderate sleep apnea for over 25 years to position the jaw forward while managing comfort and durability with biocompatible nylon. The Oasys Simplicity provides mandibular advancement. The standard Oasys with Nasal Dilators improves nasal breathing and adding Tongue Lifters improves forward tongue positioning.Protrudes the mandible forward to open the airway.Mandibular position is set to open the airway and hold this position while sleeping.For OSA, advances the tongue and mandible forward opening the airway. For sleep-related bruxism, the patented forward bite reduces or eliminates the sleep-related bruxism as well as the associated increases in heart rate, blood pressure, and cardiovascular risk. O2Vent Optima has two mechanisms of action that add stability to the airway. 1. A mechanism of advancing the jaw forward encouraging a more open airway. 2. Incorporates an airway channel that further stabilizes the airway.O2Vent Optima has two mechanisms of action that add stability to the airway. 1. A mechanism of advancing the jaw forward encouraging a more open airway. 2. Incorporates an airway channel that further stabilizes the airway.Traction appliance design, in line with the occlusal plane, promoting nasal breathing, minimizing stress on the TMJ and allowing more space for the tongue. A single set of upper and lower splints are connected through a patented rod titration system. Low profile and lightweight dorsal fin appliance. Maximizes tongue space and avoids soft tissue contact. A single set of durable upper and lower splints are adjusted using an interchangeable clip system.ProSomnus EVO uses vertically mated buccal posts to advance and hold the mandible forward to open the airway. The ProSomnus [PH] uses a continuous advancement protocol. Upper arch connects via Herbst Arm  to lower arch with an adjustment nut.ProSomnus EVO SELECT uses vertically mated buccal posts to advance and hold the mandible forward to open the airway.The airway is kept open by protrusion of the mandible with a 2-part appliance. It allows for lateral movement and mouth opening.Incorporates a vertical opening and makes more room for the tongue. Also stimulates your brain to naturally migrate the tongue forward during sleep.The device functions as a mandibular repositioner, which acts to increase the patient’s pharyngeal space during sleep.
A 2-piece, adjustable mandibular advancement device with a connector on each side, it repositions the lower jaw forward and so prevents collapse of the upper airway.
Intraoral-Scan Impression CompatibleYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYesYes
Max Protrusion/
Max Retrusion/Adjustment Increment (mm)		17/
2/
0.333		9/
0/
1		15/
5/
1		5/
0.5/
16-1		4/
1
/<0.25		10/
2/
0.25		6/
2/
1		6/
2/
1		N/A/
N/A/
0.5		5/
-1/
0.5		unlimited/
customizable/
1		12/
-1/
 0.1 		unlimited/
customizable/
1
9/
9/
1		2/
2/
N/A (no adjustments needed)		8/
-1/
0.5		7/
3/
1
Upper-Lower ConnectionConnected.Connected.
Not connected. Connected.Connected.Not connected.Connected.Connected.Connected.Not connected.Not connected. Connected.Not connected.Connected.Not connected. Connected.Connected.
Custom Accessories AvailableMouth Shield nasal breathing trainer, AM Aligner morning repositionerNoneRetention clasps, hooks & elastics, in combination with Invisalign Comes standard with hooks for elastics Advancement shims, ‘C’ cut shims, elastics, telescopic hardwareNot required.Connector bands, biteforks.Connector bands, biteforks.Pairs of interchangeable elongation-proof rods allow for a titration range from 16 mm to 34 mm in 0.5 mm increments. Patented locking mechanism prevents rods from disengaging during sleep.Titration clips (allow adjustment from -1 mm to +5 mm in 0.5 mm increments).Monogram customization options.Monogram customization options.Monogram customization options.None.None.Distal wrap, breathing hole, Denti-Trac compliance recorder, edentulous.Straps, screws.
Supporting Studytapintosleep.com/peer-reviewed-studiesNot provided.
Shrivastava D, Bixby JK,
Livornese DS, et al. Efficacy of
oral appliance therapy in the
treatment of severe OSA in
CPAP-resistant cases. Sleep
Vigilance. 2018.		Not provided.Not provided.
DOI: 10.4172/2325-9639.1000223, DOI: 10.4172/2325-9639.1000218, DOI: 10.4172/2325-9639.1000211		openairway.com/pages/clinical-resourcesopenairway.com/pages/clinical-resourcesNot provided. Not provided.Mosca E, Remmers J. Precision vs traditional oral appliance therapy: A comparison of therapeutic efficacy. JDSM 10.2. Abstract #006. (https://aadsm.org/journal/abstracts_issue_102.php)Not provided.Not provided.Not provided.Not provided. Phillips CL, Grunstein RR, Darendeliler MA, et al. doi: 10.1164/rccm.201212-2223OCNot provided.
FeaturesA CAD/CAM process uses robotics, AI, and proprietary software to custom-make these nylon appliances from intraoral scans or physical impressions. High manufacturing precision, with numerous customization options and an exclusive polishing process.Durable and thin nylon.Unique applications with upper denture, minimal dentition upper or lower, nasal obstruction or resistance, in combination with Invisalign.CAD/CAM designed for precision.Allows lateral and vertical movement without disengaging the appliance. Made less than 1 mm thick, retains durability and retention while maintaining appropriate flexibility.The Luco Hybrid is the first and only FDA cleared treatment of sleep-related bruxism.The O2Vent Optima products are OADS’ latest offering in the O2Vent oral appliance range. The lower jaw can be moved forward to a comfortable range while also allowing the integrated airway channel to bypass nasal congestion and other areas of airway collapse, such as from the tongue, soft palate, and lateral walls.The O2Vent Optima Mini is a discreet, low-profile oral device that manages the upper airway for the treatment of mild to moderate obstructive sleep apnea (OSA) and snoring. The O2Vent Optima Mini’s design (without the airway extension) may benefit patients requiring enhanced lip-seal to avoid excess saliva build-up and/or dry lips.A CAD/CAM process uses robotics, AI, and proprietary software to custom-make these nylon appliances from intraoral scans or physical impressions. High manufacturing precision, with numerous customization options and an exclusive polishing process.A CAD/CAM process uses robotics, AI, and proprietary software to custom-make these nylon appliances from intraoral scans or physical impressions. High manufacturing precision, with numerous customization options and an exclusive polishing process.Incorporates advanced materials, manufacturing robotics, and AI to advance the treatment of OSA using a precision platform. In a controlled IRB study (2021), 100% of patients preferred EVO over previous devices and CPAP; 100% of providers would recommend EVO; and 100% of providers stated EVO was easy to deliver. Features MG6 technology.ProSomnus EVO [PH], FDA cleared and Medicare E0486 verified. EVO [PH] is the only dual arm advancement device with innovative materials, manufacturing robotics and artificial intelligence designed to provide a better experience for all patients.Engineered for performance, biocompatibility and the greatest comfort. A signature variation of the ProSomnus EVO device, EVO SELECT is optimized for patients who may benefit from a more compact, effective, and easy to use precision OAT medical device using the most innovative materials.Not provided.No need for morning repositioner. 3D printed. Accurate to within 1/100th of a mm. 100 day money back guaranteed.The SomnoDent Herbst Advance Elite is a Herbst-style appliance that is individually milled from one piece of pre-cured PMMA for greater flexural strength. All the patented strength improvements in the Herbst Advance are also found in the Herbst Advance Elite. SomnoMed will replace it for free if it breaks, no questions asked, for 3 years. The Herbst Advance Elite is only supplied with a Bflex soft inner liner for increased comfort and unsurpassed retention.Not provided.
Last updated October 2023. A version of this guide published in the October 2023 issue.

Information for this guide based on data submitted by custom oral appliance marketers. Sleep Review strives for accuracy in all data but cannot be held responsible for claims made by marketers. All custom oral appliance marketers get one listing at no charge. Advertisers are offered multiple listings. All custom oral appliance options may not be included. We plan to update this guide twice a year. Email editor[at]sleepreviewmag.com to be considered for the next update.

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